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General NPI Number Information
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NPI Number | 1134774672
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Entity Type | Individual
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Provider Name | DIVINITY SARDIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST # 455G
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City | GARDENA
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State | CA
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Zip | 90248-4320
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Country | US
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Telephone | 213-443-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 9835 FLOWER ST UNIT 1523
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City | BELLFLOWER
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State | CA
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Zip | 90707-7074
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Country | US
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Telephone | 323-443-8860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 100484
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License Number State | CA
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